Partial Assignment of Disposition Form

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Partial Assignment of Disposition

Between

(hereinafter called the "Assignor")

(Assignor: all names that are on current agreement)

and

(hereinafter called the "Assignee")

(Assignee: all names to be stated on agreement)

Joint Tenants or Tenants in Common (enter percentage for each Assignee if Tenants in Common)

The assignor, being the holder of

Type of Disposition

No. in consideration of the sum of $ ,

(Disposition number)(must be at least $1.00)

payment of which is hereby acknowledged by the Assignor, hereby assigns

(Legal Description)

and the Assignee(s) hereby accept(s) and agree(s) to be bound by this assignment.

Dated this day of , 20

(Witness)(Assignor)

(Witness)(Assignee)

NOTE: The affidavits of execution overleaf must be completed unless executed under corporation seal.

The information requested on this form will be used to authorize use of public land. This information is requested in accordance with the The information requested on this form will be used to authorize use of public land. This information is requested in accordance with the Public Lands Act and is protected by the provisions of the Freedom of Information and Protection of Privacy Act. For further information, contact Land Administration at (780) 427-3570.

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AFFIDAVIT OF EXECUTION

CANADAI,

NAME OF WITNESS

PROVINCEOFALBERTA

of the

TOWIT:

in the Province of Alberta, make oath and say:

1.THAT I was personally present and did see

named in the within Instrument who is (are) personally known to me to be the person(s) named therein, duly sign and execute the same for the purpose named therein;

2.THAT the same was executed at the of

in the Province of Alberta and that I am the subscribing witness thereto;

3.THAT I know the said and

is (are) in my belief of the full age of eighteen years.

SWORN before me at

in the Province of Alberta

this day of , 20 Signature of Witness

A Commissioner for Oaths in and for AlbertaPrinted or stamped name of Commissioner for Oaths

My appointment as Commissioner for Oaths terminates:

AFFIDAVIT OF EXECUTION